Provider Demographics
NPI:1407501513
Name:KENNEY, AMANDA KAY (MSN, FNP-C, ARNP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:KAY
Last Name:KENNEY
Suffix:
Gender:F
Credentials:MSN, FNP-C, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 11TH AVENUE C
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-2819
Mailing Address - Country:US
Mailing Address - Phone:309-221-2553
Mailing Address - Fax:
Practice Address - Street 1:1008 11TH ST
Practice Address - Street 2:
Practice Address - City:DE WITT
Practice Address - State:IA
Practice Address - Zip Code:52742-1210
Practice Address - Country:US
Practice Address - Phone:563-659-9137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-16
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA167660363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily